Many people with gut issues suffer from cogitative issues and body-wide symptoms, along with the gastrointestinal hell they’re going through. One of the reasons is often high levels of D-lactic acid.
A few definitions
- acidosis – an abnormal decrease in pH levels. If systemic this is usually only a tenth of a pH level, or so, high.
- lactic acid (lactate) – an organic compound formed from fermentation, as well as by humans during normal metabolism and exercise. There are two main types discussed here D-lactic acid and L-lactic acid (two mirror-image isomers), DL-lactic acid is a mixture of the two in equal amounts. See Wikipedia for more information on D&L chirality prefixes.
- L-lactic acid – the type produced in the human body and the primary type found in the human diet. This form is easy for the body and rarely accumulates at a rate higher than the body’s ability to remove it. Short term acidosis is possible from l-lactic acid with extended strenuous exercise, but is usually cleared within a few hours. Acidosis can also occur with organ failure and other illness.
- D-lactic acid – this type is mostly foreign to the body and difficult to remove. It can easily build up, when it does this is called lactic acidosis. This article will refer it to as d-lactic acidosis to distinguish
- Lactate – In this context – the conjugate base of lactic acid, the two terms are used interchangeably.
Lactic acid actually isn’t the real culprit that causes the fatigue, brain fog, etc. (see below for symptoms). When lactic acid is formed in the body (by us during exercise, or by bacteria) hydrogen ions are formed, hydrogen ions lower the pH (make it acidic), hydrogen is the true culprit. Excess hydrogen causes problems of its own, but the increased systemic acidity is what causes many of the symptoms. If you’ve had a SIBO breath test you already know that hydrogen is a product of bacterial fermentation as the test measures both hydrogen and methane.
L-lactic Acid
Normally the body can clear L-lactic acid in real time, this is done by the liver, kidneys and through respiration (through the lungs). Only if someone is really sick (e.g. cirrhosis of live, lung disease) or they’re exercising so strenuously, over time, that the body just can’t keep up. Even after strenuous non-stop exercise l-lactic acid is cleared from the body in about 60 minutes. But the muscle pain and fatigue of exceeding the body’s ability to remove l-lactic acid can go on for days! This is due to the inflammation it brought on. If you want to know more about l-lactic acidosis talk to a long distance runner, they can probably talk your ear off about it.
Symptoms of l-lactic acidosis include: a burning feeling in your muscles (inflammation), cramps, nausea, weakness, and feeling exhausted.
D-lactic Acid
The above summarizes “normal” L-lactic acidosis; so what is D-lactic acidosis? This is where certain bacteria (see the partial list below) produce D-lactic acid. The body has a very hard time expelling D-lactic acid, therefore it tends to build up in the body quickly, and can linger for days (and remember the runner above? Even after d-lactic acid is cleared, the pain and other symptoms can last for another week after d-lactic acid is cleared!) The favorite fermentable food of D-lactic acid bacteria is simple sugars (including glucose, lactose and fructose). Have you ever felt considerably worse after that big cheat (maybe during the holidays), did you feel bad for a week after? This may have been the affects of D-lactic acid.
Symptoms of D-lactic Acidosis
- lack of muscle coordination (ataxia)
- balance and gait issues
- slurred speech (dysarthria)
- personality changes (grouchy, distant, angry, cold, hostile, aggressive, agitated, rarely – even abusive )
- memory loss (and brain fog, spaciness)
- fatigue (chronic fatigue syndrome-like symptoms, tired, lack of energy)
- “air hunger” (shortness of breath for no apparent reason)
- gas, bloating, distension, GI symptoms (unclear if these may have another common cause (e.g. SIBO) or they’re actually caused by d-lactate)
- symptoms get much worse after eating sugar or carbohydrates
Our brain is very sensitive to D-lactic acidosis (encephalopathy); D-lactate passes freely into the cerebral fluid 1. Common medical tests for lactic acid blood levels test for l-lactate, d-lactate is usually overlooked. D-lactate can also interfere with the body’s ability to utilize L-lactate as a source of fuel; the brain is especially sensitive to this. Research shows that up to 3% of people may have high D-lactate levels, this rate would be much higher in people with SIBO, dysbiosis in the colon, or a carbohydrate malabsorption 2. It is also possible that many of the symptoms people blame on die-off (Herxheimer reaction) may actually be d-lactic acid producing strains starting to proliferate, filling the gap of what ever bacteria you just killed; especially if the symptoms last for more than a couple of days.
People at the most risk for D-lactate acidosis are those with Short Bowel Syndrome, have SIBO, or malabsorb any sugars or carbohydrates. The last one is very important as it often goes overlooked and often exists with SIBO and other gut issues. For example, someone can have lactose intolerance without diarrhea; the lactose passes through the small intestine unabsorbed by us (because we may lack the lactase enzyme to breakdown the lactose (milk sugar) down into a usable form). This lactose then passes into the colon where it feeds undesirable (d-lactate producing) bacteria. D-lactate is formed and is absorbed into the blood and systemic environment, where it causes slightly lower pH levels (more acidic) and inflammation. Gas is also formed by the bacteria and can become trapped at the beginning of the colon (especially hydrogen, methane and hydrogen sulfide). This gas causes bloating, distension, and pain. You can also feel crummy for a week or more.
Common Causes of high D-lactate levels
- bacteria is the primary generator of D-lactate in mammals
- short bowel syndrome – where part of the small intestine has been removed or short due to a birth defect
- diabetic ketoacidosis (ketosis from a low carb diet will not raise d-lactate levels)
- diabetic low insulin production
- propylene glycol ingestion (antifreeze)
- roux-en-y gastric bypass surgery
- kidney or liver impairment
- Thiamine (Vitamin B1) deficiency – this is pretty rare in developed countries
- antibiotic use – antibiotics will leave the gut susceptible to opportunistic strains, which often produce large amounts of D-lactate.
What You Can Do About It
- Get SIBO under control – See The Gut Health Protocol many SIBO bacteria strains produce a lot of d-lactic acid, 24 hours per day.
- Fix any dysbiosis in the colon buy eliminating bad bacteria and rebuilding the beneficial bacteria in the microbiome. Again, see The Gut Health Protocol
- Avoid probiotics that contain d-lactic acid producing bacteria (see strains below). This means avoiding yogurt as it will always contain at least two d-lactic acid producing strains. There are few probiotics that meet this criteria. When you consume natural foods, that are naturally fermented without starter cultures (such as homemade kefir), the lactic acid often exists in the “DL” form. This is far less of a problem.
- Carbohydrate restriction, especially sugars
- Adequate hydration (avoid Ringer’s Lactate) – you must be well hydrated to clear D-lactate.
- Mind your malabsorptions! In other words, if you even think you might malabsorb lactose, fructose, sugar alcohols, etc. you must avoid them. Taking enzymes to counteract these malabsorptions (such as lactase for lactose malabsorption) only help, they do not completely eliminate the problem.
- If you can talk your doctor in to it, get tested for “D-lactate”, there is both a urine and plasma test. Both tests have to be sent to the Mayo Clinic for processing. (CPT Code 83605, Urine LOINC=14046-7, Plasma=14045-9). The Genova Organix® Dysbiosis Profile also tests for D-Lactate (available through many NDs, Functional Medicine doctors, etc). Stool tests are actually more likely to detect D-lactate than blood and urine tests as stool is where the producing bacteria are located and not all D-lactate passes into the systemic environment (e.g. blood). Insurance generally doesn’t pay for a D-lactate stool test.
Common D-lactic acid Producing Bacteria
- Opportunistic: Enterococcus faecalis, Streptococcus sanguinis, E. coli, Klebsiella pneumoniae, Streptococcus bovis, Bacteroides fragilis, and Candida freundii
- Common supplements: Lactobacillus acidophilus (yes, found in yogurt!), Lactobacillus bulgaricus (also very common in yogurt), Lactobacillus lactis (found in buttermilk), Lactobacillus buchneri, Lactobacillus delbrueckii subsp. delbrueckii, Lactobacillus delbrueckii subsp. lactis, Lactobacillus delbrueckii subsp.
bulgaricus, Lactobacillus jensenii, Lactobacillus vitulinus
The above is a partial list.
D-lactate Free Probiotic Strains
- L. plantarum – it was once believe to be a d-lactic acid producer. But more recent research shows that it produces both l-lactic acid and D-lactic acid in a racemic mixture (this is when equal amounts of left- and right-handed enantiomers (D&L) basically cancel each other out, at least for this discussion).
- Lactobacillus rhamnosus
- Bifidobacterium longum
- Bifidobacterium longum
- Bacillus subtilis and other Bacillus strains
The above is a partial list.
D-lactic acid symptoms are quite common in people with gut issues. Given that opportunistic bacteria frequently are D-lactate producers there is a good chance that blood levels for D-lactate are at least slightly elevated in these people. Reducing the D-lactate load is very important for these people. Avoidance of probiotic supplements containing these strains is a very good first step; unfortunately this does require avoiding yogurt. Getting rid of the D-lactate strains of bacteria in the gut is the next, and hardest, step. Again, The Gut Health Protocol can help with this.
1 Karton M, Rettmer RL, Lipkin EW. Effect of parenteral
nutrition and enteral feeding on D-lactic acidosis in a
patient with short bowel. JPEN J Parenter Enteral Nutr.
1987;11(6):586-9
2 Tu1813 Brain Fogginess, Gas, Bloating and Distension: A Link Between SIBO, Probiotics and Metabolic Acidosis – Gastroenterology 2014;146(5):S850-1
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Sad about yogurt 🙁 what I found I make my own using a d-lactate free starter? Is that possible ?
Emily,
This is one that I know of:
http://kulturedwellness.com/shop/kultured-wellness-yoghurt-starter/
John, can this yogurt culture be used with milk? They mention using it to make coconut yogurt.
I’m afraid I don’t know, I haven’t tried this myself. You can reach them at their contact page to see if they’ve tried it http://kulturedwellness.com/contact/
John I have sibo confirmed by breath test (hydrogen only and at the lower end) I get very spaced out after eating, more so with a carb heavy meal. It can last for the rest of the day and I tend to feel slightly drunk all the time. Assuming it’s D lactate acidosis making me feel so unwell would Water Kefir make it worse? Thanks
I believe that water kefir can produce d-lactate, however, I have not seen tests to confirm this. Another thing to consider here is an intestinal yeast infection. See Chapter 6 in The Gut Health Protocol.
Thanks John, I was convinced I had some kind of yeast issue like candida. However i did the comprehensive digestive stool analysis with Genova diagnostics and that showed zero yeast in the stool. All it showed was low diversity in the colon and fat malabsorption (pointing to Sibo which was later confirmed by hydrogen breath test). I do however have chronic sinusitis for over 2 years with nasal polyps and I have been exposed to mould in the house…
Small amounts of yeast in the small intestine can cause a lot of trouble. Small amounts in the colon are normal. So when you have a CDSA (or an OAT) and it shows a small amount of yeast in the stool it is marked as “normal”. The problem is they can’t say what is going on in the small intestine.
p.s. do you think it’s possible to have SIFO if no yeast is present on a digestive stool analysis report?
So yes, it is possible.
Get checked for brewers bacteria – it may not be yeast. See my response below with the video.
drunk feeling: made me think of yeast overgrowth, can actually produce alcohol in your system from consuming certain sugars (maltose especially) and grains, can make a total non-drinker get arrested for DUI… so, you may have a double whammy of d-lactate prooducing bacteria AND yeast overgrowth.
Hope you get it sorted out so you can feel better soon.
Btw, do you experience severe burning pain all over, especially in muscles, from the d-lactic acidosis?
forgot to mention that yeast overgrowth in the body (not necessarily limited to or originating from SIFO, can be more skin imbalances) can be caused by selenium deficiency…
I’ve read the following recommendations for selenium :
standard dose 400mcg daily
only naturally sourced by eating exactly 4 Brazil nuts daily
during yeast overgrowth, therapeutic dose to correct selenium deficiency is doubled: 400mcg 2x/day
for those disinclined to purvey and consume 8 carefully selected Brazil nuts a day until sigrns & symptoms of yeast overgrowth have abated (no more shiny rashes, itchit5ng, drunk feeling, etc.):
*mustard greens* are said to be a decent source of natural selenium, though harder time figuring out exggactly how much per volume raw vs. cooked…
supplements must be not be derived from bakers or brewers yeast!!!
Life Extension has a nice triple selenium (plus Vit E) with selenomethionine, l-selenite, and another form
all from sources other than yeast.
It is said that, like Resveratrol and Vit C, maintaining optimal selenium levels increases longevity, reducing incidence of death from all causes.
Stool testing shows low levels of acidophilus and bifido bacteria with me…..plenty of bad bacteria. Could I still have histamine issues even so?
Waiting to receive the book. Certainly need more of this information! Thankyou!
YES! A number of bad (unwanted / opportunistic / pathogenic) strains produce histamine.
I have low bifido too! Plus low in 2 others
I guess you are not aware of anyway to neutralize lactic acid? How about Hydrogen? When in a flare-up the brain fog can be debilitating, would be nice to be able to shut this off to be able to function. Thx
Is Lactose free milk (cow) ok to use in this situation?
It depends on the person. Some people also react to the casein proteins in lactose free milk. When I had SIBO I couldn’t handle even lactose free milk. But now that my gut has healed I can handle it just fine (I still have to avoid lactose, but I haven’t been able to consume that in over 30 years).
Hi John, my practitioner have come to the conclusion my sibo consists of an overgrowth of d lactate producing bacteria, As I have tested positive for all the tests, unable to tolerate any lactobacillus probiotic or fermented foods, and each antimicrobial protocol (GSE, thyme, clove, oregano, ciproflaxin) my symptoms end up far worse after each time. What herbs do you recommend for these types of bacteria? Do you suggest try different combinations or not worry about antimicrobials at all and try probiotics only? I know a macrolide antibiotic (like erythromycin) would maybe do the trick but not fix the root cause, so I am yet to reach that point yet. Thanks in advance!
David, I’m a huge proponent of preserving the beneficial microbiome as much as possible during any kill phase. Therefore I recommend supplements that have research showing selectivity, killing far more harmful bacteria than beneficial bacteria. The book The Gut Health Protocol explains all of this in detail. If you have already tested high for d-lactate it probably is best to avoid fermented foods; though no studies have been done to show that all fermented foods will actually worsen the d-lactate load, the protocol can be done without them.
I also normally only recommend probiotic strains that produce very little d-lactate and little, to no, histamine (such as my produce, Phage Complete). Not all lactobacillus strains produce d-lactate, though many do.
John please help. I will buy your book also. Sadly, I had the Roux-n-y, gastric bypass, and have had gut and malabsorption problems ever since. Am I doomed for life? Will i never be able to heal my gut permanently and restore it to at least optimal conditions? If I must never ever eat processed sugars or processed carbs again, I’ll do whatever it takes. What about fruits or whole grains avoid all of those too, forever? Do you do any coaching?
I think it will be harder for you to get your gut back in shape, but most likely not impossible. I think The Gut Health Protocol is a good place to start. Certainly avoiding grains and sugar for a while is helpful. You may have to give up lactose (dairy sugar) and fructose (fruit sugar) for good as many adults don’t absorb these properly. When sugars are malabsorbed they feed bad bacteria and create gas/bloating.
If you haven’t already joined the Facebook support group “The Gut Health Protocol” that is a great place to get advice. You will probably even find someone else that has had the Roux-en-y gastric bypass surgery.
Thank you John, very informative.
Can we buy products from you in, or from Australia? I would like to buy your Phage product as diet only helps to a certain point. I have again started kombucha and perhaps doing more harm than good, if D lactate is my problem. It is starting to make sense, I had reached a plateau.
Thanks,
Mary
Mary, definitely. Phage Complete has many happy Australian customers. We’ve also had no issues with Customs. See https://theguthealthprotocol.com/wp/phage-complete-ordering/
According to the link below, a chemical analysis of kombucha shows it contains L-Lactic acid not D-Lactic acid.
https://onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12073
Hello I hope you can help, I have had a vast array of un diagnosed symptoms this year that all started earlier this year after taking a strong course of probiotics, while being on the low fodmap diet as recommended to go on by a nutritionist. Initially like your article says I felt happy about my symptoms as I thought… ahh this must be the herxeimer reaction working that I heard about! But clearly not….
The symptoms include severe brain fog, blurry vision, confusion, memory issues, chronic dizziness, a lack of smell and taste, occasional gait disturbances, palpitations, changes in urination, numbness, feeling of being hot and the list goes on…. literally ruining my life.. almost don’t feel like I’m living in reality anymore.
The probiotics contained lots of lactobacillus acidophilus, casei and paracei, some streptococcus thermophilus and several bifidobacteriums. I have seen a lot of different people about my situation and quite honestly tired of wasting money and to hear everyone keep saying its anxiety, depression… but I know there is something else going on besides that..
I did a Genova Diagnostics test last year that showed I had no growth (dl) growth of lactobacillus. And recently last month I did a GI MAP test and it showed I now have lots of lactobacillus (even though I havent taken any probiotics for over 5 months and an overgrowth of clostridiums, streptocoocus, enerobacter and enenterococcus faecium. All which appear to be D lactate producing strains.
I have purchased your book from Amazon which will arrive tommorow. But can I ask what would be the best method to get rid of these d-lactate producing strains? What natural antimicrobioals would be effective against lactobacillus? As it appears many of them don’t effect lactobacillus. And what else can you recommend?
Many Thanks,
Antony
Sorry for the slow reply, this message kind of got lost.
Your issue sounds like in part it might be mast cell activation disorder (MCAS), commonly known as histamine intolerance (HIT). All of these symptoms can be related to MCAS (other than maybe changes in urination. Haven’t seen that one). If you are not a member of the Facebook support group (The Gut Health Protocol) I recommend that you join. You can get answers to your questions much faster there.
Benfotiamine (bioactive Thiamin B-1) 1,000mg daily
[MegaBenfotiamine by Life Extension, 250mg capsule]
for D-lactic acidosis (thiamin deficiency can be a contributing factor to acidosis), also reduces neuropathy symptoms, neuralgia, and generalized pain.
Both forms of folate B-9 will likely benefit you as some of your symptoms (e.g., loss of sense of smell aka olfactory sense) are consistent with Cerebral Folate Deficiency, a consequence of MTHFReductase Deficiency (enzyme deficiency that > 40% US population has, though typically undiagnosed… and the synthetic folic acid in overly-processed then fortified foods blocks folate receptors to brain, so supplementing only with regular bioactive folate will not replace brain’s folate deficiency, also have to take a special form of folate called Folinic Acid = calcium folinate or less common magnesium folinate… the Folinic Acid gets into the brain where it then converts to the bioactive methyl folate = MTHFolate aka Quatrefolic™)… so…
L-methyl-folate 5,000mcg by Life Extension is highest potency OTC that I have found, though a doc can write you a Rx for Deplin which is about 3x more potent (~15,000mcg) and can be prescribed for depression…
This L-methyl-folate should help with fatigue, as folate is needed for red blood cells plus is one of the 4 essential nutrients for mitochondrial function [energy production: food–>ATP] in all cells;
(the other mito essentials beyond Folate are CoQ10, Carnitine, Alpha Lipoic Acid).
CoQ10 best active form being Ubiquinol which is deficient in the brains of sufferers of Myalgic Encephalomyelitis aka Chronic Fatigue Syndrome and is the cause of the fatigue…
best form of the other mito essentials are Acetyl-L-Carnitine (works in brain as well as body) & R-Lipoic Acid (significantly more potent than ALA), plus these two mito essentials work well with Benfotiamine as a trio formula for neuralgia/neuropathy if taken in high enough doses.
Back to folate: in addition to methyl-folate for your body,
Folinic Acid (OTC form of Rx Leucovorin) is the folate compound that crosses blood-brain barrier… to treat your loss of sense of smell, plus is ideal for age-related memory/cognitive issues (many eventually diagnosed with Alzheimer’s just actually are deficient in folate in the brain)… 800mcg is highest Folinic Acid I have found, by Source Naturals (“MegaFolinic”) and a few other brands. Some people advise taking higher doses of B-12 as methyl-cobalamin to thwart folate side effects… Good idea to take a complete bioactive or sometimes termed “activated” B-complex to cover all bases, especially as several B vitamins work together for different functions…
Lastly, for histamine reduction and general inflammation control as well as mast cell activation syndrome, Rx Gastrocrom is hard to obtain, but you can benefit from mast-cell stabilizing Quercetin phytosome (Life Extension, BioQuercetin phytosome, I take 3-4x the recommended dose to equal full non-phytosome dose of 800mg 2x/day)
plus NasalCrom spray for use topically on skin where I get itching or hives rash (urticaria). Many seemingly unrelated symptoms can arise from overstimulated mast cells (which contain not only histamine, several kinds, but also heparin, serotonin, leukotrienes, inflammatory cytokines/chemokines/200+ inflammatory mediators! anything that stimulates the mast cells can cause all of those chemicals to come pouring out and flood the whole system… countless miseries…)
Good luck!
Auto-Brewery Syndrome – the #1 misdiagnosed condition, because no one is looking for alcohol. Your symptoms are classic ABS. go out and purchase an alcohol breath meter. The best ones are sold at BAC Track. Blow into it before and after meals. Track your levels. If your alcohol levels are not .00, and they are higher, you have ABS. my husband and I’s story is here:
https://www.ny1.com/nyc/all-boroughs/news/2018/05/25/staten-island-man-with-auto-brewery-syndrome
If you are still struggling I would look into POTS and ME/CFS. They often coincide with with MCAS that John mentions below. They can also all be set off by some form of trauma. Most often its a viral or bacterial infection. Long after the infection has resolved itself these problems linger. Everything you mentioned I experience on a regular basis.
Best of luck
Ally
Those with high lactic acid, grumpy, sleepy have found to have Auto-Brewery Syndrome. it’s the #1 misdiagnosed syndrome because doctors are not looking for alcohol in people who don’t drink. Our story is below. There is a first ever book out on ABS called “My Gut Makes Alcohol”
https://www.ny1.com/nyc/all-boroughs/news/2018/05/25/staten-island-man-with-auto-brewery-syndrome
Thanks for the information John. I’m hoping you can make a very small revision for those of us suffering from Myalgic Encephalomyelitis, commonly referred to as: Chronic Fatigue Syndrome. ME/CFS is soooooooo much more than just being fatigued all the time. It’s chronic pain, migraines, digestive issues, heart palpitations, cognitive problems, orthostatic intolerance, insomnia, temperature regulation, visual disturbances, sound sensitivities, mood swings, anxiety and more. It relates so much to what you speak about and recent discoveries link it to a lactate problem. More specifically, people with ME/CFS have a problem with ATP production. For some reason, our mitochondria is relying more heavily on Anaerobic Respiration- thus, we produce too little ATP and too much lactic acid. ME/CFS affects up to 4 million Americans. Many of whom are house-bound and bed-bound. It can be absolutely devastating and unfortunately the name “Chronic Fatigue Syndrome” hasn’t been very affective in helping people understand the true nature of our illness. I hope you will look into it. I’m sure you’ll find it fascinating. I also hope that you will considering removing the name Chronic Fatigue Syndrome from your symptoms list and perhaps adding the patient preferred term Myalgic Encephalomyelitis or even ME/CFS. We really need awareness.
https://www.ted.com/talks/jennifer_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose?language=en
https://stanmed.stanford.edu/2016spring/the-puzzle-solver.html
Hi, I have high D-lactic acid from Lactobacillus Acidophilus overgrowth and leaky gut, Will Phage complete work for me?
Kanin, Yes it will. Phage Complete does not add to a d-lactate load. It also produces no histamine if that is important to you.